Gastroparesis | Overview
Gastroparesis is a condition in which the stomach muscles do not work properly. As a result, food empties from the stomach very slowly, or not at all. Children with this disorder may feel full all the time, be very nauseous, have pain, or vomit undigested food left in the stomach. There isn't yet a cure for gastroparesis. In some cases, it gets better after a few months to years, and in others it may be a lifelong condition. But with proper management and diet, specialists can help you and your child control the symptoms.
What are the symptoms of gastroparesis?
The most common symptom of gastroparesis is vomiting. Children with this condition often get sick late in the day after a meal and commonly vomit foods eaten several hours earlier. Other symptoms may include:
- upper abdominal discomfort or pain
- feeling full after small amounts of food
What causes gastroparesis?
Experts don't yet know exactly what causes gastroparesis. In many cases, it starts after an infection. Other risk factors include:
- surgery, particularly fundoplication, a procedure that controls reflux in patients with gastroesophageal reflux disease (GERD)
- medications, such as anticholinergics and certain chemotherapy drugs
- congenital defects that affect the stomach or abdomen, such as gastroschisis, which cause a baby's intestines to stick out of the body
- other underlying conditions, including diabetes, hypothyroidism, neurologic disorders, or metabolic disorders such as Riley Day syndrome
How we care for gastroparesis
If we suspect that your child has gastroparesis, we will recommend motility testing to evaluate and diagnose the condition. Boston Children's Hospital is known worldwide for our advanced gastrointestinal motility testing services. In fact, many of our motility doctors are pioneers in the development of the newest, noninvasive tests. Once your child has been diagnosed, the team of experienced clinicians in Boston Children's Motility and Functional Gastrointestinal Disorders Center will work with you and your child to develop a personalized treatment plan that draws from the latest therapies and research available.
Gastroparesis | Diagnosis & Treatment
How is gastroparesis diagnosed?
If your doctor suspects your child may have gastroparesis, they may order one or more of the following tests.
Gastric emptying scintigraphy
This nuclear medicine test uses an external scanner that tracks radioactive materials (eaten by your child in food) as they move through the digestive system. A four-hour emptying test has become the gold standard for diagnosis and is available at Boston Children's Hospital. Experts are developing even newer tests for the evaluation of gastric emptying.
An antroduodenal manometry test places a small, flexible tube (catheter) through the nose into your child's stomach and small intestine to measure pressure. If your child has a gastrostomy (feeding tube), your physician may insert the catheter through that instead.
Wireless motility capsules
Your child swallows a capsule containing a tiny device that measures pH, temperature and pressure levels as it travels through the digestive system. The capsule transmits real-time data to a monitor worn by the patient.
How is gastroparesis treated?
The first step in treating children with gastroparesis is to address any underlying conditions and stop any medications that may contribute to the problem. Other treatment options may include:
- Special diet: Your child's physician and dietician will develop a customized diet plan involving smaller portions and easily digestible foods. You will learn how to choose the best foods, plan meal times and balance eating with exercise.
- Medications to control nausea: Drugs called antiemetics may decrease nausea and vomiting.
- Medications to improve stomach emptying: Prokinetic drugs may improve stomach function in some children. Some medications like cisparide, domperidone or botulinum toxin injection to the pylorus are only available through specialized programs like those at Boston Children's Hospital. These medications should be prescribed and managed by physicians with pediatric motility expertise.
- Pain control: We provide a multidisciplinary team to control pain and improve quality of life.
- Gastric electrical stimulation: This treatment involves surgically implanting a neurostimulator in your child's stomach. The device delivers mild electrical pulses to the stomach muscle to control nausea and vomiting.
- Surgical jejunostomy: In some children, gastroparesis is so severe that they cannot keep down any food or liquids. In these cases, a surgeon may need to place a jejunostomy (feeding tube) directly into your child's intestines so they get proper nutrition.